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General NPI Number Information
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NPI Number | 1104842566
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Entity Type | Individual
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Provider Name | MELVIN R GONZAGA MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 957 NATIONAL HWY, STE 3 ATTN: MELVIN GONZAGA
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City | LAVALE
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State | MD
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Zip | 21501-0929
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Country | US
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Telephone | 240-362-7128
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Fax | 240-362-7129
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Provider Business Mailing Address
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Address Line | 957 NATIONAL HWY, STE 3 ATTN: MELVIN GONZAGA
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City | LAVALE
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State | MD
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Zip | 21501-0929
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Country | US
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Telephone | 240-362-7128
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Fax | 240-362-7129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D22148
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License Number State | MD
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